An anatomic anal sphincter-saving procedure for rectal cancers located at anorectal junction.

Autor: Mariolis-Sapsakos T; Consultant General Surgeon Surgical Department, Agioi Anargyroi General and Oncologic Hospital of Kifisia, National & Kapodistrian University of Athens, University of Athens, Athens, Greece., Psathas G; Surgical Department, Agioi Anargyroi General and Oncologic Hospital of Kifisia, University of Athens, Athens, Greece., Nikolouzakis TK; Laboratory of Anatomy-Histology-Embryology, Medical School of Heraklion, University of Crete, Heraklion, Greece., Laschos K; Oncology Pathology Department, Agioi Anargyroi General and Oncologic Hospital of Kifisia, Athens, Greece., Triantopoulou C; Radiology Department, Konstantopouleio General Hospital, Athens, Greece., Bonatsos G; Surgical Department, Agioi Anargyroi General and Oncologic Hospital of Kifisia, National & Kapodistrian University of Athens, University of Athens, Athens, Greece., Tsiaoussis J; Laboratory of Anatomy-Histology-Embryology, Medical School of Heraklion, University of Crete, Heraklion, Greece. tsiaoussis@uoc.gr.
Jazyk: angličtina
Zdroj: World journal of surgical oncology [World J Surg Oncol] 2019 Aug 02; Vol. 17 (1), pp. 131. Date of Electronic Publication: 2019 Aug 02.
DOI: 10.1186/s12957-019-1672-y
Abstrakt: Background: This study aims to present the feasibility of the open approach of hemilevator excision (HLE) as a promising alternative of the laparoscopic and/or robotic ones for the treatment of low rectal cancer extending to the ipsilateral puborectalis muscle.
Methods: A 60-year-old male patient with a high-grade differentiated rectal adenocarcinoma at the right side of the lower rectum invading puborectalis muscle. The proposed operation consists of a combination of extralevator abdomino-perineal excision (ELAPE), intersphicteric resection (ISR), and low anterior resection (LAR) since it resects the ipsilateral to tumor levator ani muscle (LAM) from its attachment at the internal obturator fascia and the deep part of ipsilateral external anal sphincter (EAS), while the distal part of dissection is completed in the intersphincteric space taking out the internal anal sphincter (IAS). At the contralateral side of the tumor, the dissection plane follows the classic route of LAR.
Results: Pathology proved the oncologic adequacy of resection. MRI at the fourth postoperative week showed clearly the right aspect of anorectal junction free of tumor. Anorectal manometry revealed a fair anorectal function which is in accordance with the findings of clinical assessment of patient after restoring large bowel continuity (post-op Wexner score, 7).
Conclusion: This is the first case of the open HLE that seems to be a good alternative compared to ELAPE or conventional APR, as it offers oncologic adequacy and a fair anorectal function.
Databáze: MEDLINE
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